Zusammenfassung
Die unterschiedliche Biologie der wichtigsten Entitäten des Schilddrüsenkarzinoms (papilläres, follikuläres, gering differenziertes, anaplastisches und medulläres Karzinom) beruht überwiegend auf deren unterschiedlichem Metastasierungsverhalten. Papilläre Karzinome (PTC) metastasieren fast ausschließlich lymphogen in 20–50 % der Fälle in Halslymphknoten, während Fernmetastasen in < 5 % auftreten. Eine zervikale Lymphadenopathie kann das erste Symptom eines papillären (Mikro-)Karzinoms sein. Im Gegensatz dazu metastasieren follikuläre Karzinome (FTC) praktisch nur hämatogen; insgesamt zeigen 10–20 % der FTC Fernmetastasierung. Bei Diagnosestellung zeigt ein Drittel der medullären Karzinome (MTC) Lymphknotenmetastasen und in 10–15 % Fernmetastasen; weitere 25 % entwickeln Metastasen während des Krankheitsverlaufs. Gering differenzierte (PDTC) und anaplastische Karzinome (ATC) metastasieren sowohl hämatogen als auch lymphogen. In differenzierten Karzinomen (PTC, FTC) sind Fernmetastasen somit relativ selten und im Falle des Auftretens meist noch mit einer geringen Tendenz zur Progression verbunden. Die am häufigsten betroffenen Organe sind die Lungen und Knochen. Metastasen in Gehirn, Brustdrüse, Leber, Nieren, Muskel und Haut sind relativ selten oder selten. Die Schilddrüse kann auch das Zielorgan anderer Malignome sein. In Autopsieserien von Patienten mit metastasierendem Tumorleiden ließen sich Schilddrüsenmetastasen in bis zu 10 % der Fälle nachweisen. In Schilddrüsenoperationspräparaten bei klinischem Malignitätsverdacht fanden sich in 1,4–3 % der Fälle Metastasen anderer Organtumoren. Am häufigsten metastasieren Nierenzellkarzinome (48,1 %), kolorektale Karzinome (10,4 %), Lungenkarzinome (8,3 %), Mammakarzinome (7,8 %) und überraschend häufig Sarkome (4 %) in die Schilddrüse.
Abstract
The different biological features of the various major entities of thyroid cancer, e.g. papillary, follicular, poorly differentiated, anaplastic and medullary, depend to a large extent on their different metastatic spread. Papillary thyroid cancer (PTC) has a propensity for cervical lymphatic spread that occurs in 20–50 % of patients whereas distant metastasis occurs in < 5 % of cases. Cervical lymphadenopathy may be the first symptom particularly of (micro) PTC. In contrast follicular thyroid cancer (FTC) has a marked propensity for vascular but not lymphatic invasion and 10–20 % of FTC develop distant metastases. At the time of diagnosis approximately one third of medullary thyroid cancer (MTC) cases show lymph node metastases, in 10–15 % distant metastases and 25 % develop metastases during the course of the disease. Poorly differentiated (PDTC) and anaplastic thyroid cancer (ATC) spread via both lymphatic and vascular invasion. Thus distant metastases are relatively uncommon in DTC and when they occur, long-term stable disease is the typical clinical course. The major sites of distant metastases are the lungs and bone. Metastases to the brain, breasts, liver, kidneys, muscle and skin are relatively rare or even rare. The thyroid gland itself can be a site of metastases from a variety of other tumors. In autopsy series of patients with disseminated cancer disease, metastases to the thyroid gland were found in up to 10 % of cases. Metastases from other primary tumors to the thyroid gland have been reported in 1.4–3 % of patients who have surgery for suspected cancer of the thyroid gland. The most common primary cancers that metastasize to the thyroid gland are renal cell (48.1 %), colorectal (10.4 %), lung (8.3 %) and breast cancer (7.8 %) and surprisingly often sarcomas (4.0 %).
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Schmid, K. Lymphknoten- und Organmetastasen des Schilddrüsenkarzinoms. Pathologe 36 (Suppl 2), 171–175 (2015). https://doi.org/10.1007/s00292-015-0071-6
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DOI: https://doi.org/10.1007/s00292-015-0071-6
Schlüsselwörter
- Lymphogene Metastasierung
- Hämatogene Metastasierung
- Fernmetastasierung
- Papilläres Karzinom
- Follikuläres Karzinom